Homelessness and End of Life Care: A Qualitative Analysis of the Living Wills of Underprivileged Individuals

Abstract

The major objective of this study is to test an advance directive (AD) intervention in the homeless population of Minneapolis and St. Paul.

This project will address the end of life (EOL) concerns of homeless people and provide the basis to test the needs of others who are separated from their loved ones and/or experience episodic healthcare.

Estimates of the number of homeless people in the United States range up to several million.

In the Twin Cities metro area over 4,000 youth and adults are in temporary housing programs and over 600 are unsheltered.

“Homeless” is defined as having no regular place to live (i.e. having to stay in a shelter, a hotel paid for with a voucher, a friend’s house, an abandoned building or outdoors).

Among disadvantaged populations, homeless individuals experience the greatest risk of death, barriers to healthcare and lack of resources and close relationships deemed necessary for proper EOL care.

Homeless individuals are admitted to the emergency room and hospitalized at almost four times the rate of the general population of the United States.

Although homeless individuals experience such high rates of mortality and hospitalization, their attitudes, values and desires regarding EOL care had yet to be studied.

Their concerns have generally been ignored, since most EOL care has focused on the concerns of the white middle class.

In general, homeless people have been found to be very willing to describe their preferences and concerns and eager to have a voice in what the future may bring in the event of serious illness or death.

Homeless people have been found to have very unique concerns regarding healthcare and EOL care, since they frequently witness sudden and violent death on the streets.